Neurol. praxi. 2021;22(3):201-205 | DOI: 10.36290/neu.2021.005

Progress in therapy of autoimmune neuropathies

doc. MUDr. Edvard Ehler, CSc., prof. MUDr. Ivana Štětkářová, CSc., MHA

Neurologická klinika FZS Univerzity Pardubice a PKN, Pardubice

Neurologická klinika FN Královské Vinohrady a 3. lékařské fakulty UK, Praha

Autoimmune neuropathies develope on the gound of immune reaction against own tissue. The tissue can be myelin sheath, proper axon or vascular supply - vasulitis. In only few neuropathies the antibody is known (e.g. GQ1b in Miller-Fisher syndroma) and in other neuropathies the autoantibodies are suspected or some other autoimmune reaction is considered. Corticosteroids are contraindicated. In chronic inflammatory polyneuropathy the treatment begins with induction therapy - intravenous application of immunoglobulins or oral medication with corticosteroids with the target dosis of 1-2 mg pro kilogram of body mass. In rare cases plasma exchange or immune adsorption are used. More frequently subcutaneous application of immunoglobulins comes to use. For chronic medication corticosteroids, immunoglobulins (intravenous or subcutanneous) and combined with immunosuprresives, because of corticoid - or immunoglobulin-sparing effects. In variants with IgG4 class antibodies a monoclonal antibody rituximab is effectively used. In the treatment of multifocal motor neuropathy are immunoglobulins (intravenous or subcutaneous) most frequently in use. Looking to substantial adverse reaction is cyclophosphamid used only for a short period.

Keywords: autoantibodies, polyradiculoneuritis, immunoglobulins, plasma Exchange, corticosteroids.

Received: December 20, 2020; Revised: January 14, 2021; Accepted: January 14, 2021; Prepublished online: January 14, 2021; Published: October 1, 2021  Show citation